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HomeMy WebLinkAbout026-1064-10-500 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bu;lding Division Sanitary Permit No: 463082 0 e ' � INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Halle Builders Inc. I Richmond Township 026- 1064 -10 -500 CST BM Elev: Insp. BM Elev: IBM Description: Sectionlrown /Range /Map No: 66 , 1 Z' C. -'�''— 21.30.18.318A40 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Desingi / Alt. B M ' ' )' /� . q Aeration Bldg. Sewer Holding St/Ht Inlet cf TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet •�� `� Septic (51/ Dt Bottom Dosing Header /Man. �•D J ,�c Aeration Dist. Pipe Ib , cij G 1 z Holding Bot. System o J /Q ,15 7 '7, f � PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM G f b Model N ber TDH Li Friction Loss System TDH Ft Forcemain Dist. to Well _T SOIL ABSORPTION SYSTEM BED/TRENCH Width � �' Length No. Of Trenches IT DIMENSIONS No. Of Pits Inside Dia. Liq id Depth - DIMENSIONS Z5 q1 � .Z" ' fe N , ` N-` 11_� SETBACK SYSTEM TO I P/L JBLDG IWE LL LAKE /STREAM LEACHING Manufacturer I� INFORMATION Type Of System: CHAMBER OR -L.1 1 A— UNIT Model Numbe • a Ue.� a tick - Z ( Zy ILl �t' i DISTRIBUTION SYSTEM z?, 4_ ZZ Header /Manifold r/ Distribution x Hole Size x Hole Spacing Vent to Air take � Length Pipets ` \ g \ \ �{ I lLength � Z. Dia Dia Spacin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edge To soil \ g p Yes No �` Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / ! Location: 1452 112th St New Richmon WI 54017 (NW 1/4 NE 1/4 21 T30N R18W) NA Lot 4 Parcel No: 21.30.18.318A40 A'a_ 1.) Alt BM Description =4� 2.) Bldg sewer length = �� - amount of cover = r - - Pla n revision Re uired? Yes ��.' No Use other side for additional information. formation. - I, - Date Insepc Cart. No. SBD -6710 (R.3/97) d < = zrnOr Cl T pn c z m z � rn ❑ $ m ;a t) 00 3 X ••� � - Qrn X m 0 ,� o K _ CO) --� m n X c v c z Vr -� X �:. i'11 z _ Z N �' Z c v CA z z co 7c n G) m Cn c p = z m M G) C Z m O N W rn — Z F O v v m z ,N O � 3 T C oo = s N rn ( s V V v v z ' I z ow O =� L ¢ y co z sr RECEIVED --- !� 2004 L zo, irFIC Safety and Buildings Division County r 201 W. W. Washington Ave., P.O. Box 7082 Np iscon s i n Madison, WI 53707 Sanitary Permit Number (to be filled in by Co.) Dep artment of Commerce ( 608 ) 261-6546 Q f c ,L. Sanitary Permit Application State Plan I.D Num In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide A may be used for secondary purposes Privacy Law, s 15.04(1 Project �Address (if different than mai ing address) I. Application Information - Please Print All Information 7 � 57 Property Owner's Name _ —� t) r ) Parcel q F Block S Property Owners Mailing Tess (/ Property Location 3111 r Yo City, State Zip Code Phone Number N 4 � a Section — . 7 /J 6 '7 a circle one) IL Type of Building (check all that that apply) g� T � N; R or® A l or 2 Family Dwelling - Number of Bedrooms Subdivision Name M Number ❑ PublicC4mrnercial - Describe Use �- / S / Z - S3 O State Owned - Describe Use , CeN S w 2 2 4- - 4 % tr ❑ 'Aag J0Townshi f III. Type of Permlt: (Check only one box on Une A. Complete line B If appUcable) A New S� ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only U Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that appl Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ R,ecircuMnS Synthetic Media Filter eLeaching Chamber ❑ Drip Line ❑ vel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: y / /( Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Re wired s is Q Q P 9 (� persaJ Aria Proposed (sf) System Ele ati VI. Tank Info Capacity in Total Number Manufacturer Prefab Sic. Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Nc Existing Tanks Tanks Septic or Holding Tank Aerobic Treatmeat Unit Dosing Chamber VII. Resp onsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plum *'s Name (Print) Plum Si re P PRS Number Business Phone Number u G b3S7 [ 7/ , 57-d( o 8-eo?'5' Plumber's Address (Street, City, S te, Zip /) P & if r /( u� ✓ �U cJ VIII. oun /De artment Use Onl Approved 0 Disapproved Sanitary Permit F (includes Groundwater Date sued 4 1s6ingAge)t Signature (N s) Surcharge Fee) l71 l Q 0 11 Owner Given Reason for Denial b 0 I CV r0K0l;,rova UR easons for Disa roval 1 Septic tank effluPn + +ii +cr �..d l a dispersal cell must all be serviced / maintained (�/ as pe m� — ement plan provided by plumber. �.dyt.l�2- 2. Ail setback requiremen s �L � „ /)� ��- e S . as per applicable code /ordinances. , �r� Al D 4�5 �13Ma ;0o � a a PEW 10 j) �0b qk 94, X00 9 �oa• a ' -BOY-/ s 6 4 y 7. YS I Pu- L,4-�w r qo f 150 ,4 ®13M / 00- 5 s l - 3 1 a ip qk go, /- o T i T6, 9Y 9L sin Do% ntofIndustry SOIL AND SITE EVALUATION REPORT Page 1 of 3 nd Human Relations ofr ly & Bt,ildings, in accord with ILHR 83.05, Wis. Adm. Code ., COUNTY '� St. Croix ' ,ch complete site plan on paper not lesrt�o��jr inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal refer *) dir ion and % of slope, scale or dimensioned, north arrow, and locatio a ce to nearest road. pending APPLICANT INFORMATION — P- E sE Pf;F Ak,t11NFORMATION RRE �WD DAT PROPERTY OWNER: PROPERTY LOCATI N Ron Derrick �' { GOVT. LOT ➢ 1/4 NW 1/4,S 21 T 30 N,R 18 g (or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # /S 1505 Hy. #65 na csm (0 Z CITY, STATE ZIP CODE P 0 N PER ❑ fTY ❑VILLAGE MOWN NEAREST ROAD New Richmond, WI. 54017 (.715,..2 i5,—' 0 Richmond 112th. St. (x] New Construction Use Residential / r of bedrooms 4 ( ] Addition to existing building [ ]Replacement ( ] Public or commercial describe ,�{ �.� �+et4L � T Code derived daily flow 600 gpd Recommended design loading rate bed, gpd /ft gpd /ft �y Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate -- ,7 -- bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s ft (as referred to site plan benchmark) Additional design/ site considerations alt. area system el . = 96.95' Parent material oL wash Flood plain elevation, if applicable _na It L U = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK =U nsuitable fors stem KI S ❑ U Z S ❑ U KI S ❑ U RIS ❑ U EIS ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Y Bed Trer>ch 1 —11 10yr3/3 none 1 2mgr mfr gw if .5 .6 2 1 -19 7.5yr4/4 none is Osg mvfr gw if .7 .8 Ground 3 9 -36 7.5yr4/6 none ms Osg ml gw na .7 .8 elev. 4 1 6-68 5yr4/4 none cos 0 g ml na na .7 1.8 1 Depth to limiting factor +8 8 , Remarks: Boring # 1 � 1-8 10yr3 /3 none 1 2msbk mfr gw if .5 .6 2» 2 1 -17 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 7 -36 7.5yr4/6 none ms Osg ml gw na .7 .8 Ground elev. 4 6 -90 5yr4/6 none so c sg ml na na .7 .8 1 01.4 ft. 7 Depth to limiting factor +90" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. M. New Richmon WI 54017 Signature: Date: 5 -11 -2000 CST Number: m02298 - l PROPERTY OWNER Ron Derrick SOIL DESCRIPTION REPORT Page 2 A T PARCEL I.D. # pending A Depth Dominant Color Mottles Structure Boring # Horizon Texture Consistence Boundary Root in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Be 1 -12 10yr3 /3 none 1 2msbk mfr gw if .5 .6 3 ;' ............. 2 12 -29 10yr4 /4 none sicl 2msbk mfr gw If .4 .5 Ground 3 9 -69 7.5yr4/6 none ms Osg ml gw na .7 .8 elev. 1 Qaa ft 4 9 -90 5yr4/6 none co-'s Osg ml na na .7 .8 Depth to limiting factor +90" Remarks: Boring # 1 -15 10yr3 /3 none 1 2msbk mfr gw if .5 .6 4 2 15 -31 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 ................. 3 1 -55 7.5yr4/6 none Osg mvfr gw na .7 .8 Ground elev. 4 5 -88 5yr4/6 none co s Osg ml na na .7 .8 lo ft. Depth to limiting factor +88" Remarks: Boring # 1 -20 10yr3 /3 none 1 2msbk mfr gw if .5 1 .6 5 2 0 -32 10yy4 /4 none sicl M na gw if na .2 3 2 -86 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 10 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Ron Derrick 1554 200th Ave. CSTM2298 ,*W4NW4 S21- T30N -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #If-csm This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of SE lot survey stake @ el. 100.00' Alt. BM.= top of 1 pvc pipe el. 100.95' MU �N v B c7Q'� �2I 2 1 ' 113 Gary L. Steel 5 -11 -2000 Wis4bnsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division Safety.& Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less t inches in size. Plan must include, but not limited to vertical and horizontal refe �o�nj, -( QGt�dir 'on and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and locatio al ance to nearest r`" d. pending APPLICANT INFORMATION - ^ F� \ E P ik"NFORMATION REVIEWED BY DATE -. . PROPERTY OWNER: PROPERTY LOCATIO Ron Derrick - r - -.�uU GOVT. LOT 1i4 1 /4,S 21 T 30 .N,R 18 § (or) W PROPERTY OWNERS MAILING ADDRESS � °r ,� LOT # BLOCK # SUBD. NAME OR CSM # 1505 Hy. #65' "' na csm CITY, STATE ZIP CODE P 0 BER, ❑CITY ❑VILLAGE MOWN NEAREST ROAD New Richmond, WI. 54017 (719 2 &c 0 Richmond 112th. St. r • [x] New Construction Use [ 3¢ Residential / er of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended'design loading rate --,7— bed, gpd /ft gpd/ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate _ bed, gpd /ft . 8 trench, gpd/ft Recommended infiltration surface elevation(s) 97.45 ft (as referred to site plan benchmark) Additional design/ site considerations alt area system el .-= 96.95 - Parent material out wash Flood plain elevation, if applicable _na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem F L I S ❑ U Z S ❑ U Jos ❑ U ® S ❑ U EIS ❑ U EIS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourg Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITmr& 1 1 -11 10yr3 /3 none 1 2mgr mfr gw if .5 1.6 r7'11S `..... 2 1 -19 7.5yr4/4 none Osg mvfr gw if .7 .8 Ground 3 9 -36 7.5yr4/6 none ms Osg ml gw na .7 .8 elev. 4 6 -88 5yr4/4 none co s Osg ml na na .7 :.8 1 0 -, 4 ft. Depth to limiting factor +8 8" Remarks: Boring # 1 � -B 10yr3 /3 none 1 2msbk mfr gw if .5 ':.6 ...•2 "`' -17 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 r4 A 7 -36 7.5yr4/6 none ms Osg ml gw na .7 .8 Ground elev. 6 -90 5yr4/6 none so c Osg ml na na .7 1.8 1 01.4 ft. Depth to limiting factor +90" _j Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Aw, New Richmonck WI 54017 Signature: Date: 5 -11 -2000 CST Number: mO2298 PROPERTYOWNER Ron Derrick SOIL DESCRIPTION REPORT Page 2. qf�3 PARCEL I.D. # _Pending i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/tF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITiench 3 1 -12: 10yr3 /3 none 1 2msbk mfr gw if .5 .6 2 12 -29 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 9 -69 7.5yr4/6 none ms Osg ml gw na .7 .8 elev. 1 00-9 ft. 4 9 -90 5yr4/6 none co s Osg ml na na .7 : .8 Depth to limiting factor Remarks: Boring # 1 -15 10yr3 /3 none 1 2msbk mfr gw if .5 .6 lv 2 5 -31 10 r4 4 :�Y y /4 none s icl 2msbk mfr gw If .4 .5 3 1 -55 7.5yr4/6 none ms Osg mvfr gw na .7 .8 Ground elev. 4 5 -88 5yr4/6 none co s Osg ml na na .7 .8 1 00.6 ft. Depth to limiting factor +88" Remarks: Boring # 1 -20 10yr3 /3 none 1 2msbk mfr gw if .5 .6 4 2 0 -32 10yy4 /4 none sicl M na gw if na .2 3 2 -86 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 10 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) I STEEL'S SOIL SERVICE Gary L. Steel Ron Derrick 1554 200th Ave. CSTM2298 NW4NW4 S21- T30N - R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #5 -csm This soil evaluation vas conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as pe rmanen t lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of SE lot survey stake @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 100.95' \ /V 5' A 3A M Ib ®� t2 1 2' 113 + as Gary L. Steel 5 -11 -2000 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations fl of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix t` not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # 0 2 � dimensioned, north arrow, and location and distance to nearest road. y ►,t ndln 7 APPLICANT INFORMATION -PLEA R 11, IEWE DATE .._ ORMATION fL cf i PROPERTY OWNER: PROPERTY L ATION Ron Derrick 0 NW 1/4 NW 1/4,S 21 T 30 N,R 18 R (or)W PROPERTY OWNER'S MAILING ADDKZSS LOT # # SUED. NAME OR CSM # 4, .__ , -, - �� 4 na C. 1909 HY. 465 CITY, STATE ZIP COD ' " PHONE BER - ❑VILLAGE GMWN NEAREST ROAD 1 1 .� New Richmond, WI. '54017 46 -230 Richmond 1 112th. st. (x] New Construction Use pt: ] Residential %Number of bedr 4 [ ] Addition to existing building j ] Replacement (] PublioAr commercial de Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpd /0 8— trench, gpd/ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate _ bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 101.00 ft (as referred to site plan bencch�rr�rk) Sys - Additiorial design / site considerations nas Parent material outwash Flood plain elevation, if applicable na o S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT GRE SYSTEM IN FILL HOLDING 7TA U= Unsuitable fors stem EIS ❑ U 0 S ❑ U KI S ❑ U ® S ❑ U ®(S 11 U ❑ S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bo Bed Trench 1 0 -12 10yr2 /2 none 1 2msbk mfr gw if .5 .6 1 r 2 12 -33 10yr5 /4 none sicl M na gw if np .2 Ground 3 33 -90 745yr4/4 none rco S ml na na .7 .8 elev. 1 Depth to C4 limiting factor Remarks: Boring # 1 1 0-8 10yr2 /2 none 1 2msbk mfr gw if .5 .6 >Y > €€ 2 18-24 10yr5 /4 none sicl M na gw if nip .2 3 24 -32 7.5yr4/6 none ms Osg mvfr gw na .7 .8 Ground elev. 4 32- 90 5yr4/6 none co s sg ml na na .7 .8 1 Depth to limiting factor Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. v . New Richm WI 54017 Signature: Date: 5_11 -2000 CST Number: m02298 PROPERTY OWNER Ron Derrick SOIL DESCRIPTION REPORT Page `2 of _3 PARCEL I.D. # pending A la Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 -11 10yr2 /2 none 1 2msbk mfr yw if .5 .6 3 2 1 -27 10yr4 /4 none scil 2msbk mfr gw if .4 .5 Ground 3 7-45 7.5yr4/6 none Osg ml yw na .7 .8 elev. 10 ft. 4 5 -88 5yr4/6 none co s sg ml na na .7 .8 Depth to limiting factor + Remarks: Boring # 1 -10 10yr2 /2 none 1 2msbk mfr gw if .5 .6 E 4 2 0 -26 10yr4 /4 none sic 2msbk mfr gw if .4 .5 3 6 -44 7.5yr4/6 none co s sg ml gw na .7 .8 Ground elev. 4 -88 5yr4/6 none co s sg ml na na .7 .8 10 ft. Depth to limiting factor +88" Remarks: Boring # 1 -11 10yr2 /2 none 1 2msbk mfr gw if .5 .6 5 2 1 -29 10yr4 /4 none si 2msbk' mfr gw if .4 .5 �i•:C \ ?:iLj$:: 3 9 -52 7.5yr4/6 none co s sg ml gw na .7 .8 Ground elev. 4 2 -90 5yr4/6 none co s g ml na na .7 .8 10 ft. Depth to limiting factor T-1 +90" Remarks: Boring # Ground elev. ft. Dep to IimiU ng factor Remarks: SBD- 8330(R.05/92) r ' STEEL'S SOIL SERVICE Gary L. Steel ?, Ron De rick 1554 200th Ave. CSTM2298 Nw4Nw4 S21 -T ON - R 18W New Richmond, WI 54017 MPRSW -3254 town of Ric and (715) 246 - 6200 lot #4 -csm 7 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 BM.= top of 1 pvc pipe C el. 100.00 Alt. BM.= top of 1 pvc >pipe C el. 101.30' { � 'V 0 A � � � 3 4 -V ID' X00 + Gary L. Steel �` 5 -11 -2000 �S let Ata i� Sep 24 04 02:03p LISA ANN KROLL 715- 246 -5700 p.6 09/24/2004 13:52 7152467227 HALLE BUILDERS INC PAGE 05 ANNKUVLL) 4 - rAlvisp7,osieoewpnseCOaes� leg JUN Z 6 2001 i •J � di •e,•�fr�,ro /' 1''0.x►` 6 d 1 MW ` ''��l•.: '' MAP Located b of the Sa dhwat Quarter of the Northecst quarter of Seems, 21 end part of the Southeea Quarter of iM Mwtheaet qusRr of Section 2Q wt In TomehO 30 North, 111ea9a to Mat Town of Rlehmond, St. Crodl County, wUeernln. Prepared for and at the rawest of: I far CAWDF 13M State YOU .55. f New Riehmoad. 1M 541717 Drafted hie Ty It D.aq. e �i o ''j� >Zr .01 a f� i a I a' � _I 0 i _ g o rr n tONAW I QT' Ir- vie _�.•' ., •,,... ... 2S � � �, �� L o 3 3 0 S ! \ 'I n FAST ! cawi f v summ 1030-/s 4rASr &7'XI1F4 //4 SECIIt11l !O N irca �MISi f/7 t1 swairan 521.]0' 1 � ' • ..... ?f�t� -re Moftsr all : f Rx�r WA r�DErac r 3. co Ir o N r -4 % IS ix OF i u w I JOINT ww Qf n �ASEtEliT �� S� i �a u r a r - .. L o F p �Ca S 301'E 560.77' k spa0 # 0 1. u lP Gl �i'WtQ 11i eye 6r = 1'7s Loam' f '" '"a,`"�t I • y .� Zi SC SI is P L ., � Pa►ad b% 2 � ►a � P ,r AD a ``I JEO Consulting Group. Inc. Za6.a1' ta7�S - 1 1610 Now or or Phone No (715) 246 -431P -- Now R mon 1 1911 7 Ball 325 �. Car Cr ve Sir r/4 BEMINGS ARE REteEWICED TO 111E EAST -MAST 1/4 OF auua LINE OF SEC710N 20. Tow"SHIP 31 N« RANCE 16 tL a� ar 7lK t D (ANDS WNW IS ASSUMED TO BEAR N69'Y3rW a r 1114 CI01MMI71 NOTE: The parcels shown an this m ore subject to Slotq County and r pOY rr - JG - N Township lows, rube end rtguicUons (Lo. wetlands, miWpnum lot site. Dawes to Awed, atc.1 Scare purchoong or developing any portal, contact the St. Sheet I of Crals County Zoning OMee and the opproprlate Town Board for advice. Sep 24 04 06:20p LISA ANN KROLL 715 - 246 -5700 p.2 09124/2004 14 :13 7152467227 HALLE BUILDERS INC PAGE 02 ST CROIX COUNTY SEPTIC TANK MAD�NANEE AGREEMENT OWNERSHW C ERTIRCATION FORM OwnerBuyct Azz &AgK Pe Address / � e f- I wt 0 t7 pfoperty ddress for oe+v ooh) (Vcdfial an from - Q CityJState ��W le( 'D W + Parcel Idattifiodon Numbet _ O r U, DESCIiDWON , 31 M of pity Location lJW %. Pla v, sec. r 3� rt - W. Town >AYt #. Subdivision Certift Sttroey 1VLap # V.I. _ ys a V Vchune gage # a s . wtuTantp Yhed # —. Spoa bou iaf Ym 0 00 Lot limes idm fiiablex ym 0 no woandta aofY� mOO" idiewltiaitsp [rmsaaeiailt+tebobsadlc+r es-> into thea�stean PQ vat 15e aeptic tmlt eves► am yem or wooer. if WO&d by a boeased ptaa W What you P� aaas b of paoepID6 in ehe wrasce disposal ""m can afltect the fast � � �� 1>n1� as a treatment staEe s oc oa Own, sjg by the ow= and by a The pcvl+at)► owner abases a twit b 9t. 7$ DaPamaatt . �tlt (1) tha m•ai'esvastewstecdhpOW aY&t= a plttoabeti7aa °� ' tsabic0odptuatba t laoeased Of neorss+ty), &c � Unk is less thsn 113 f U of dW8m is in p mper op�g o�i� =Nbr (2) aloes mspearos P _ m dim the Immam WmP � wim Ids a0eae rds fo[!b. bareia. as at 1+Y 1he Dep�om�eat of i' snd DeP of Piatmal R.=M Stm of Wia000sw- gip ststiaE that yon owe SYSIR basbeesmaiataiaed aaaxbe =WPlcUd and t wxwd to to St. 000 Comfy Zoe Office wdbm 30 days of ft dwm yeas �. DATE MM CRRTTFICAUON_ I we am ate t]ac oa►e<eKs) of 1(we) �Y ati v , dsod trot cosdad i of Deeds Oi ( ) (.,, /) ,"*",Y �zl ? I L71 a DATE APPLICANT mWcPm5c2tcd smolt is dw sail"" pamat b*Wg wt,*ked by ft zvoiio6 DqWtWmt, •• «... N lsidude with t4is appliestion a stamped wwt=W deed tom the Rcgisw of Dssds off= S cc" of the ccrdfied savvy MP if mfete000 v made in the wunnty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner l Septic Tank Capacity Z O? L S740 g al ❑ NA Permit # /.. O b 'L,/ Septic Tank Manufacturer e 13 (13 DESIGN PARAMETERS f Y Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model _ Mo ❑ NA Number of Public Facility Units A Pump Tank Capacity a l ❑ NA Estimated flow laverage) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) �j ©� al /day Pump Manufacturer ❑ NA Soil Application Rate g al/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L � NA ❑ At -Grade ❑ Mound 5 Fecal Coliform (geometric mean) 10 cfu /100ml ` ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: [3 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA AR Y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ Y onth(s) (Maximum 3 years) 13 NA Clean effluent filter j � '� � At least once every: / ` ❑ W yeaarr(lss) ) m ❑ NA ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) Flush laterals and p ressure test At least once eve ❑ mo ye ar(s) ❑ NA P ever ❑ yearls) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replace ent system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. Iv T alua ' a o ing tank b e taile ITE , nR- N/&'V✓ Co N S7?RtlC-:n D ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 15t. G ( Phone Phone "� /S— 3g(, This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Parcel #. 026- 1064 -10 -5500 10/01/2004 04:15 PM PAGE 1 OF 1 Alt. Parcel #: 21.30.18.318A -40 026 - TOWN OF RICHMOND Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): " = Current Owner * HALLE BUILDERS INC HALLE BUILDERS INC 1113 HWY 64 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description * 1452 112TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 W ITC Legal Description: Acres: 1.950 Plat: 1295 -CSM 15/4112 026/01 SEC 21 T30N R18W PT SW NW BEING CSM Block/Condo Bldg: LOT 04 15/4112 LOT 4 1.950AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21- 30N -18W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 10/31/2003 745284 2446/425 WD 10/31/2003 745283 2446/424 WD 07/16/1998 583159 1341/057 WD 07/23/1997 930/54 more 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 30,100 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.950 28,600 0 28,600 NO Totals for 2004: General Property 1.950 28,600 0 28,600 Woodland 0.000 0 0 All 1.950 28,600 0 28,600 Totals for 2003: General Property 1.950 28,600 0 28,600 Woodland 0.000 0 0 Total 1.950 28,600 0 28,600 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 09/24/2004 13:52 7152467227 HALLE BUILDERS INC PAGE 06 • U 2446P 925 � ?4S>284 XATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2. 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO.. WI RECEIVED FOR RECORD This Deed, made between Church of the Immaculate Conception ,10/31%2003 09: 30AN of the Blessed Virgin, a Wisconsin religious corporation, MARRANTV DEED EXEWt 4 Grantor. and Halle Builders, Inc. REC FEE: 11. TRANS FEE: 90.00 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of the Southwest Quarter of the Northwest Quarter (SW 1/4 of NW 1/4) Recording Arco of S t, ange est, ws: Name and Return Address Lot 4 of Cen;4;�A Sntvcv Mao filed Jun 27, 2001 in Volume 1 S, Page 41 Judith A. Itemiagton Document No. 649534. REMINGTON LAW OFFICES P.O. Box 177 New Richmond, WI 54017 026 -1064 -10-500 r 3l D d A j i) -- Pam0-1 umber (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: municipal and'zoning ordinances, easements and restrictions of record. Dated this __ f% day of October 2003 Church of the Immaculate C eptin" a Blessed Virgin • + Father Allan P. Bradt , Vie e President * Francis Otto, Secretary AUTHENTICATION ACKNOWLEDGMENT I Signature(s) _ STATE OF WISCONSIN ) ss. ST. CROIX County ) authenticated this day of ' Personally came before me this 2 day of October 2003 the above named Father Allan P. Bradley, as Vice President, and Francis Otto as " Secretary, of the Church of the immaculate Can on. _ e TITLE: MEMBER STATE BAR OF WISCONSIN Slesyed Virgin ( to me known to be the person(s) who executed : .gtLg - authorized by § 706.06, Wis_ Stats.) instrument and acknowled ed the same. THIS INSTRUMENT WAS DRAFTED BY + v • Judith A. Remington, I#emiaMen Law Offices, Notary Public, State of Wisconsin • ..''Q P.O. Box 1 , New Richmon My Commission is permanent. ( not, state expt ' (Signatures may be authenticated or acknowledged. Both site not necessary.) ,.... 3' ' Names of persons signing in any capacity must be typed or printed below their signature, [� WARRANTY DEr%n is ca�a"r• t �� du t x, wi STATE. BAR OF WISCONSIN � FORM No. 2 - 1941 um Sep 24 04 06:21p LISA ANN KROLL 715 -246 -5700 p.6 ! 09/24/2004 14.13 7152467227 HALLE BUILDERS INC PAGE 06 c3 ' N Z� i Al A O �sw %L g � T I s a O X , m S , , e , , , , i L---------------------- - - - - -3 Sep 24 04 06 :20p LISA ANN KROLL 715 - 246 - 5700 P.• z �89/2Z20 I«la 7546722 HALE 131JT DERS INC PAGE e � COL.§ jw g§ U- %$ | |) . & � ® ;. lb- � \ � � �| '� § ow �� � � �_ ` �■■ ■ j | 2 ® . ; | � it � |� al l IR § 2 q \ ■ k ( Ils _ |R - - ! •. ' || - t „ � � � 1: h III1�9 11: 1 l v' 1 il I i Il _ MI ( ��;I ■� � ���j;j muiimniniiiu ���nn����glll 1111lll�ii � ; I'! no IU ■■ !,I: All, lil u /111) � ii , ��• ��• :i.,l 1 ` ■`ii.. ter■ ow .i :_ � ; � � � I � • L� � � � II11H111111111 11 ` I� ,. 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